No abstract

Background: Although gastro-oesophageal reflux is a recognised cause of chronic cough, the role of oesophageal dysmotility is unknown. The aim of this study was to determine the prevalence of abnormal oesophageal motility in a selected group of patients with chronic cough. Methods: Oesophageal manometry and 24 hour pH monitoring were performed in 43 patients with chronic cough, 34 of whom had symptoms suggestive of gastro-oesophageal reflux. Comparative manometric measurements were made in 21 healthy subjects. Results: Nine patients with chronic cough had normal manometry and 24 hour pH. Of the remaining 34 patients, 11 (32%) had abnormal manometry alone, five (15%) had abnormal 24 hour pH monitoring alone, and in 18 (53%) both tests were abnormal. Only one patient in the control group had manometric abnormalities. Conclusions: These results point to a previously unrecognised high prevalence of abnormal oesophageal manometry in patients presenting with chronic cough. Oesophageal dysmotility may therefore be important in the pathogenesis of cough in these patients.

Fifty-nine consecutive patients admitted for colonoscopy were randomized to receive polyethylene glycol or sodium picosulphate. Patients expressed their opinion in a questionnaire and the endoscopists, blinded to the preparation, assessed the cleanliness of different segments of the colon.There was no statistically significant difference in the tasteacceptability of the preparations, frequency of nausea, abdominal pain, peri-anal soreness or sleep disturbance between the two groups. Polyethylene glycol caused vomiting in 13 % of patients while this was absent in those who received sodium picosulphate (P < 0.05).The average number of stools passed was 12.4 in the polyethylene glycol and 8.6 in the sodium picosulphate groups; mean difference 3.8(95 % C.I. 0.7-6.9) with P < 0.02. The overall cleanliness of the colon was better in the polyethylene glycol group (P = 0.002) as judged by the blinded colonoscopist. There was less delay (P = 0.06) and more

Ninety-three adult patients with benign esophageal stricture were randomized to receive balloon or bougie dilatation. Eighty-five patients were eligible for analysis and were followed prospectively for a year. Twenty-four patients required repeat dilatation within a year, but 50 patients completed a year's follow-up without further dilatation. The bougie group initially had a better symptomatic result, experiencing significantly less dysphagia at five months, although this difference had disappeared at one year. Eighteen patients in the balloon group required redilatation for symptoms compared with six in the bougie group. The bougie group had a significantly greater increase in their stricture diameter, and this was still present at one year after dilatation. There was no significant difference in safety or patient acceptability. Balloons are probably more costly to use than bougies. Bougie dilatation is to be preferred to balloon dilatation in adults except in special circumstances.

It is a common observation that stricture patients with severe dysphagia may have a wide lumen, while others with a narrow stricture have few swallowing complaints. In 64 patients with benign oesophageal stricture the dysphagia score (determined by questionnaire and by a test meal both based on nine different items of food scored according to their solidity) was compared with the diameter of the stricture measured radiologically by premeasured barium spheres. There was evidence of an association, but the correlation coefficient (r) was O0544(p=O00001), suggesting that the diameter of the stricture is an important, although not the sole, determinant of dysphagia. Stricture diameter explains 29-6% (r2) of variation in dysphagia score. The patients (mean dysphagia score 71 of a maximum possible 90) were divided into three groups according to the severity ofoesophagitis (19 patients had minimal, 22 moderate and 23 severe oesophagitis). Analysis revealed the mean dysphagia score to be 83,73,59 in each group respectively. Dysphagia score of each group was significantly different from the others (Kruskal-Wallis test). Relating the dysphagia score to stricture diameter for each group gives correlation coefficient r=0379 (p=OllO) in the minimal oesophagitis group, r=0-651 (p=0-001) in the moderate group, r=0 583 (p=0 004) in the severe group. If both diameter and severity of oesophagitis are included then 66-0% of the variation can be explained. It is concluded that the degree of oesophagitis is as important as luminal diameter in determining swallowing ability.